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Clinical Quiz

Hyponatremia in an Alcoholic Man

A 50-year-old man with history of alcohol abuse was sent to the emergency room (ER) after developing generalized weakness. He was recently diagnosed with hypertension and started on lisinopril and hydrochlorothiazide 2 weeks prior. He typically drinks 8 beers a day and drinks a lot of water to “stay hydrated.” He attempted to stop his…

Abdominal CT scan showing 2 adrenal adenomas.

Two Left Adrenal Masses in a 62-Year-Old Man

A 62-year-old black man initially presented to discuss bilateral clinically localized stage I, cT1bNxMx, bilateral multifocal renal masses  (5.6 × 5.4 cm and 1.3 × 1.2 cm right lower pole renal masses; 4.9 × 4.8 cm left interpolar renal mass) suspicious for synchronous bilateral renal cell carcinomas. He was also noted to have 2 left…

Figure 1. Patient's kidney biopsy images. Light microscopy showed focal glomerulosclerosis (A) and meningeal and endocapilary proliferation (B). Electron microscopy showed electron dense deposits in the meningeal region (C). The podocyte foot processes are well preserved.

A Case of Hematuria in a Young Woman

A 19-year-old Asian woman with no significant past medical history was referred to the nephrology clinic for hematuria. She noticed tea-colored urine 3 days after an upper respiratory illness. It lasted for 1 week. During that time, urinalysis showed 3+ blood, 1+ protein, >60 RBCs. Since then, she has had recurrent pink-tinged urine lasting a…

Case: A 32-year-old Man With a Left Testicular Mass

A 32-year-old Caucasian man was diagnosed with a left 1.2 cm solid testicular mass during evaluation of new gynecomastia (see image). He underwent a computed tomography scan of the chest, abdomen, and pelvis that did not demonstrate evidence of retroperitoneal lymphadenopathy and his tumor markers (AFP, B-HCG, LDH) were within normal limits.

A Rare Case of Post-renal Obstruction Causing AKI

A 61-year-old man with no significant past medical history presented to the hospital with bilateral flank pain and 20 lbs weight loss in the previous few months. Computed tomography (CT) showed bilateral ureteral obstruction in the mid-ureter with thickening of tissue around the great vessels. There were no stones. These findings are consistent with retroperitoneal fibrosis.…

A 66-year-old Man With Bilateral Renal Masses

A 66-year-old black man initially presented for evaluation of incidentally detected, Stage I, cT1aN0M0, synchronous, bilateral, clinically localized tumors that were suspicious for renal cell carcinoma (RCC). He has a history of hypertension but is otherwise healthy, with normal renal function (creatinine 0.80 mg/dL; estimated glomerular filtration rate >60 mL/min/1.73m2). Triphasic abdominal imaging (see figure)…

A Man With Elevated Serum Creatinine, History of Gout

A 40-year-old man presented for evaluation from his primary care doctor with an elevated serum creatinine level. Of note, his grandmother died from kidney failure, and his father suffered from kidney failure and underwent a kidney transplant at age 50 years. No family members suffer from gout. The patient’s only medication is a multivitamin. Physical…

Acute Interstitial Nephritis With Granuloma Formation

A 51-year-old African American male with a history of tobacco use, hypertension, gastroesophageal reflux disease, and benign prostatic hyperplasia, is found to have an elevated Creatinine on a routine visit. He has no cough, fever, dyspnea, chest pain, abdominal pain or any lower urinary tract symptoms. Medications include Amlodipine, Terazosin, Pantoprazole, and Budesonide/ formoterol formoterol…

2.4 cm right renal mass

A Caucasian Man With a Right Renal Mass

A 53-year-old Caucasian man initially presented to discuss management options for an incidentally noted and mildly enhancing (24 to 50 Hounsfield units) 2.4 cm right renal mass (circled region in image) found during a workup for abdominal pain. After discussing treatment options, the patient elected to proceed with a robotic partial nephrectomy for definitive management. 

Figure 1. CT abdomen of this patient shows three radio-opaque stones in the left kidney.

An Asian Man With Recurrent Kidney Stones

A 60-year-old Asian man with history of recurrent nephrolithiasis, congenital solitary left kidney, gout, hypertension, pre-diabetes was seen in nephrology clinic. Since his 20’s, he has had multiple lithotripsy and ureteral stenting procedures to remove stones and to relieve hydronephrosis. He has a strong family history of kidney stones and gout. His creatinine was 1.5…

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